Sen. Nelson Wants Nebraska's Sweet Medicaid Deal For Every State

Rather than surrender to the criticism that Nebraska should be treated like every other state, Sen. Ben Nelson, D-Neb., told his hometown paper Tuesday that he's now fighting to bring the Nebraska treatment to the rest of the country.

Senator Ben Nelson. i i

Senator Nelson speaks with reporters on Capitol Hill. AP hide caption

itoggle caption AP
Senator Ben Nelson.

Senator Nelson speaks with reporters on Capitol Hill.


"Whatever Nebraska gets will be available to all states," he told the Omaha World-Herald. "Regardless of the language in the bill, my intent has been and remains absolutely clear - every state should be treated the same."

He's referring, of course, to the hotly contested deal he cut with Senate leaders last month. In a bid to win the crucial 60th vote in favor of the health overhaul, Democrats amended their bill to cover the full cost of Medicaid expansions in his state forever. The other 49 states would have to shell out for a portion of the massive expansions of the state-run programs that insure low-income people, beginning in 2017.

The deal ignited instant criticism from some Democrats and Republicans at every level. Sen. John McCain, R-Ariz., and others called it the "cornhusker kickback," and a group of 13 state attorneys general threatened to sue on the basis that a special arrangement for Nebraska would be unconstitutional. (Nebraska's own attorney general, a Republican, declined to join the fray.)

Nelson asked the group's leaders to "call off the dogs" a few days ago, saying he intended the deal to be available to all states, according to a memo circulated by an aide to South Carolina Attorney General Henry McMaster.

The obvious question raised by Nelson's latest plan is the cost. The CBO said Nebraska's special treatment would cost $100 million over the next ten years, but new spending as a result of the deal wouldn't even begin until 2017, since Washington would pick up the extra Medicaid tab for the first few years everywhere.

The cost of a similar deal nationwide could rack up quickly. The Senate's version of the overhaul would extend Medicaid to adults earning up to 133 percent of the poverty line around the country, making it a far more generous program in many states. In Arkansas, for instance, working parents must earn less than 17 percent of the poverty line to qualify.

If Nelson can't get the Nebraska bargain for all the states, he's hoping for a compromise that would allow them to opt out of the Medicaid expansion beginning in 2017, when they have to start paying up. That could be a lot to swallow for cost-conscious Democrats who would have to balance the added costs to the federal government with the possibility of losing hard-won gains in expanding coverage to uninsured people.

Weaver is a reporter for Kaiser Health News, a nonprofit news service.



Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.